"Linkage to care" among people living with HIV - definition in the era of "universal test and treat" in a sub-Sahara African setting.

Background Prompt linkage to human immunodeficiency virus (HIV) care after diagnosis is of utmost importance for individual health and reduction of HIV transmission. Different definitions for llinkage to carer have challenged comparisons as a public health marker. Its meaning in the era of luniversal test and treatr has transformed in all settings, but is most relevant in sub-Sahara Africa, where the burden of new HIV infection is still highest. Methods For this narrative review on llinkage to carer definitions with a focus on sub-Saharan Africa, we searched PubMed/Medline between September and December 2020, restricted to the period 2000n2020 using Boolean operators: lHIVr AND (llinkage to carer OR lengagement in carer) and screened for institutional definitions of llinkage to carer. Additionally, as one example of a rural sub-Saharan African setting, we analysed linkage steps within the Chronic Diseases Clinic Ifakara (CDCI) and its associated Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) in rural Tanzania between 1 January 2017 and 31 March 2019. Results We analysed 81 articles that included llinkage to carer within different study settings and HIV organisations. Major differences in defining llinkage to carer exist, according to setting and location, patient populations and the timing of steps within the linkage process. We identified 16 different numerators and 10 denominators used to define linkage with time periods ranging from lsame day as diagnosisr up to 12 months after diagnosis among 34 original articles from sub-Saharan Africa. At the CDCI, 1149/1671 (69%) newly diagnosed individuals were enrolled into care after diagnosis. Three months after enrolment into care, 94%, 86%, 85% and 71% of enrolled patients had a laboratory evaluation, a clinical evaluation, were initiated on treatment and had a first clinical follow-up visit after initiation of treatment, respectively. Duscussion To address the inconsistency in defining llinkage to carer and in order to guarantee the comparability of llinkage to carer in the sub-Saharan Africa region, we support the definition from the European region with some adaptions. We suggest a priority list of care indicators if more than one care indicator is available for successful llinkage to carer in the era of luniversal test and treatr for sub-Sahara Africa.